Characteristics of Anxiety Disordered Children with Symptoms of Autism

Background: The prevalence of anxiety disorders in children with high functioning autism is estimated to range from 35 – 84.1% (White et al., 2009), rates that have garnered attention and sparked efforts to adapt cognitive-behavioral therapies (CBT) for use in youth with autism spectrum disorders (ASD; MacNeil et al., 2009). In contrast, research on the converse of this comorbidity, the presence of ASD symptoms in children with primary anxiety disorders, is lacking, though such symptoms may be particularly elevated in children with non-ASD psychopathology (Constantino, Lajonchere, Lutz et al., 2006) and may influence the effectiveness of individual CBT (Puleo & Kendall, 2010).

Objectives:  To evaluate demographic and diagnostic characteristics of youth with principal anxiety disorders and elevated autism-related symptoms. 

Methods:  The sample consisted of 100 clinic-referred youth (ages 7- 18 years) who met diagnostic criteria for a principal diagnosis of social phobia, separation anxiety or generalized anxiety disorder (as determined by the Anxiety Disorders Interview Schedule for Children, ADIS-C/P; Silverman & Albano, 1996). A series of ANOVA, t-test and chi-square analyses examined the participant characteristics (age, race, gender, SES), diagnostic profiles (number and type of diagnoses), self- and parent-reported coping skills (Coping Questionnaire; CQ-C and CQ-P; Kendall, 1994), and clinician rated distress (i.e., ADIS-C/P severity rating scores and Children’s Global Assessment Scale; CGAS; Shaffer et al., 1983) of youth with or without elevated levels of ASD symptoms (i.e. a T-score ≥ 60 on the Social Responsiveness Scale-parent version).

Results:  A substantial number (N = 42) of anxious youth endorsed elevated levels of ASD symptoms. The demographic and diagnostic profiles of these youth largely resembled those of youth without elevated ASD symptoms in terms of presentation, principal and comorbid diagnoses, and anxiety severity.  However, youth with elevated ASD symptoms had more diagnoses, t(98) = -2.08, p = .04, particularly more specific phobias,  t(98) = -2.07, p = .04, and were more likely to present with social phobia, χ² (1, N = 100) = 4.84, p = .03. Further, after controlling for the presence of social phobia, youth with elevated ASD symptoms were more likely to list social concerns among their top fears than youth without such symptoms, χ² (2, N = 100) = 5.59, p =.03; Nagelkerke R² = .32.

Conclusions: Some important distinctions in the presentation of anxious youth with and without elevated ASD symptoms were identified: youth with elevated ASD symptoms had more complex diagnostic profiles, characterized by more specific and social phobias. However, limited other differences between groups suggests that children with elevated ASD symptoms may not be easily distinguished from children without such deficits in clinical practice.  Given evidence that family CBT may be more effective than individual CBT for youth with anxiety disorders and elevated ASD symptoms (Puleo & Kendall, 2010), more routine screening of ASD symptoms in anxious youth seems warranted.